Atypical perinuclear antineutrophil cytoplasmic antibodies in patients with Crohn's disease.
Atypical perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) occur in most patients with ulcerative colitis but only in a minority of those with Crohn's disease. In a recent study from the United States, this serological marker was reported to be present in 100% of Crohn's disease patients with a clinical phenotype of' left-sided ulcerative colitis' but was not present in patients with 'isolated' small bowel disease. In a previously reported survey from the author's hospital, the p-ANCA status of 247 consecutive patients with Crohn's disease was evaluated, and, of these, 33 Crohn's disease patients were seropositive, including 18 (13.0%) with combined small and large bowel disease, 11 (19.6%) with 'isolated' colorecral disease, and four (4.6%) with 'isolated' small bowel but no detectable colorectal disease. To further evaluate and verify the significance of atypical p-ANCA in these 33 patients, clinical, radiological, endoscopic and histological features were examined. This study confirms that an 'ulcerative colitis-like' clinical phenotype may be seen in most, but not all, serologically positive Crohn's disease patients. Moreover, 'isolated' small bowel disease in the absence of colorectal disease occurs. Detection of atypical p-ANCA in Crohn's disease with different clinical and pathological features provides serological evidence that Crohn's disease is a very heterogeneous disorder.
Freeman
H J
HJ
Department of Medicine (Gastroenterology), University of British Columbia, Vancouver.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D001004:Anus Diseases / Q000473:pathology; D015415:Biomarkers / Q000032:analysis; D002648:Child; D003093:Colitis, Ulcerative / Q000276:immunology / Q000473:pathology; D003108:Colonic Diseases / Q000473:pathology; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology / Q000473:pathology* / Q000601:surgery; D017577:Cutaneous Fistula / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D005069:Evaluation Studies as Topic; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005500:Follow-Up Studies; D006099:Granuloma / Q000473:pathology; D006801:Humans; D007412:Intestinal Fistula / Q000473:pathology; D007420:Intestine, Large / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011859:Radiography; D012002:Rectal Diseases / Q000473:pathology; D014624:Vaginal Fistula / Q000473:pathology
D019268:Antibodies, Antineutrophil Cytoplasmic; D015415:Biomarkers